If you are interested in becoming an Agent for IEE in your country, please fill out the following information regarding your organization. We will contact you for further details.

Name of Agency:

Primary Contact Person:

Address:

City, State:

Country:

Phone Number:

Fax Number:

Web Address:

E-Mail:

Number of Years in Business:

Year Business Established:

What Countries do you Recruit from:

Indicate what Programs are you Interested in:

*Business Lisence Number:

Does your country require you to register with the government to run an exhange program?

Have you previously sent exchange visitors to the United States?

If so, how many per year?

For theWork and Travel Program:

What visa Sponors have you worked with:

How many participants to you anticipate sending to the United States:

What are the official University summer dates for students to participate in the program

Start Date

End Date

For theInternship or Training Program

What visa Sponors have you worked with:

How many participants to you anticipate sending to the United States:

What type of Positions are your participants interested in?

References:

Please list three business references you have worked with in the United States - Please include U.S. Designated Sponsors you are currently working with

Reference #1

Phone Number:

E-mail Address:

Company Name:

Contact Person:

Years of association:

Reference #2

Phone Number:

E-mail Address:

Company Name:

Contact Person:

Years of association:

Reference #3

Phone Number:

E-mail Address:

Company Name:

Contact Person:

Years of association:

How did you hear about IEE?

What fees to your charge for Work and Travel?

Fes for Intern/Training?

Do your fees include SEVIS Fees?

*Third parties, either domestic or overseas, with whom IEE contracts to assist with recruiting, selecting, screening, orienting, placing, training, or evaluating foreign nationals who participate in training, internship and work and travel programs must enter into a written agreement with IEE outlining the full relationship between the parties on all matters involving the Exchange Visitor Program.